Rhombic Flap Reconstruction after Mohs Micrographic Surgery for Premalignant Lesions and Skin Cancer / 대한피부과학회지

BACKGROUND: Recently, increasing attention in the field of dermatological surgery has been paid to treating skin cancers, including both premalignant and malignant lesions. The rhombic flap, one of the transposition flaps, is an outstanding method for reconstructing small- to medium-sized defects after skin surgery. OBJECTIVE: The aim of this study was to evaluate our clinical results with the rhombic flap for reconstruction after Mohs micrographic surgery (MMS), including the cosmetic aspects, complete surgical excision, and recurrence. METHODS: Between June 2010 and September 2013, 37 patients who were diagnosed with premalignant and malignant lesions on the face and extremities were treated with rhombic flaps for the reconstruction of primary cutaneous defects following lesion excisions. We reviewed the medical records and evaluated the clinical aspects and surgical treatment outcomes, and the cosmetic results were scored as excellent, good, fair, or poor. In addition, we assessed the surgical treatment outcomes using the Vancouver Scar Scale (VSS). RESULTS: Thirty-seven patients received 37 rhombic flaps. The cosmetic results of the reconstructions were gratifying, and 28 of 37 patients (75.7%) showed good to excellent results. Specifically, the cosmetic results of the modified rhombic flaps were great, and 27 of 30 patients (90.0%) showed good to excellent results. The cosmetic results on the VSS showed a high mean score (2.9). CONCLUSION: Our study showed that the rhombic flap is a simple reconstruction method and provides aesthetically pleasing results. Therefore, it could be a useful option for reconstructing defects of the face and extremities.

Rhombic Transposition Flap: Its Modifications and Application in Skin Tumor Surgery / 대한피부과학회지

BACKGROUND: There is currently an increasing demand in the field of dermatology for surgical therapy for treating skin cancers, including premalignant and malignant lesions. The rhombic (often referred to as rhomboid) flap is a transposition flap that is an excellent option for reconstructing small to medium-sized defects after skin surgery. Objective: We analyzed our clinical results of using the rhombic flap for reconstruction after skin cancers, and especially in regard to the aspects of cosmesis, complete surgical excisions, recurrence and the scope of dermatosurgical care. METHODS: From July 2004 to May 2008, forty one patients who were diagnosed with non-melanoma skin cancer or benign tumor on the face, trunk and extremities were treated with a rhombic flap or its modified form for the reconstruction of primary cutaneous defects following the excision of tumor. The cases were divided into groups according to the cosmetic units and the clinical outcomes were reviewed, and cosmetic results were scored as excellent, good, fair or poor. RESULTS: Forty-two rhombic transposition flaps were done in 41 patients. Among these patients, 16 were men and 25 were woman. There were 23 cases of malignant tumor and 19 cases of premalignant and benign tumors. Thirty two cases were located on the face (12 on the cheek, 7 on the nose, 5 on the forehead and periorbital area, 2 on the mouth and 1 on the ear) and 10 cases were located on the other sites (4 on the trunk, 2 on the buttock, 2 on the finger, 1 on the arm and 1 on the leg). There was tumor recurrence in one case. The cosmetic results of reconstructions were satisfactory, and 29 cases out of the 42 (69%) cases showed good to excellent results after 6 months. CONCLUSION: Rhombic transposition flap can be a simple and good choice for reconstructing cutaneous defects on the face, trunk and extremities after skin tumor surgery. It could also be applied to the defect with limited skin laxity without tension or distortion, and it especially showed excellent and good cosmetic results in most of the cases.

Rhombic Transposition Flap: Its Modifications and Application in Skin Tumor Surgery / 대한피부과학회지

BACKGROUND: There is currently an increasing demand in the field of dermatology for surgical therapy for treating skin cancers, including premalignant and malignant lesions. The rhombic (often referred to as rhomboid) flap is a transposition flap that is an excellent option for reconstructing small to medium-sized defects after skin surgery. Objective: We analyzed our clinical results of using the rhombic flap for reconstruction after skin cancers, and especially in regard to the aspects of cosmesis, complete surgical excisions, recurrence and the scope of dermatosurgical care. METHODS: From July 2004 to May 2008, forty one patients who were diagnosed with non-melanoma skin cancer or benign tumor on the face, trunk and extremities were treated with a rhombic flap or its modified form for the reconstruction of primary cutaneous defects following the excision of tumor. The cases were divided into groups according to the cosmetic units and the clinical outcomes were reviewed, and cosmetic results were scored as excellent, good, fair or poor. RESULTS: Forty-two rhombic transposition flaps were done in 41 patients. Among these patients, 16 were men and 25 were woman. There were 23 cases of malignant tumor and 19 cases of premalignant and benign tumors. Thirty two cases were located on the face (12 on the cheek, 7 on the nose, 5 on the forehead and periorbital area, 2 on the mouth and 1 on the ear) and 10 cases were located on the other sites (4 on the trunk, 2 on the buttock, 2 on the finger, 1 on the arm and 1 on the leg). There was tumor recurrence in one case. The cosmetic results of reconstructions were satisfactory, and 29 cases out of the 42 (69%) cases showed good to excellent results after 6 months. CONCLUSION: Rhombic transposition flap can be a simple and good choice for reconstructing cutaneous defects on the face, trunk and extremities after skin tumor surgery. It could also be applied to the defect with limited skin laxity without tension or distortion, and it especially showed excellent and good cosmetic results in most of the cases.

A Case of Squamous Cell Carcinoma of the Ear Helix Successfully Treated with Rhombic Transposition Flap

Approximately 6% of all head and neck skin cancers arise from the external ear, of which squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) are the most common. Acquired helical rim defects can be caused by injury or after excision of a tumor. Since many patients feel that the auricle has a functional and cosmetic importance, it is crucial to consider the esthetics. In cases where the defect exposes bare cartilage, second-intention healing is usually not achieved. Therefore, full-thickness skin grafts have been adopted, but the healing time is long and in many cases, mismatch of color between the grafted skin and the surrounding ear has been observed. Alternatively, reconstruction with flaps may provide optimal coverage. Among the many possible flap designs, the rhombic transposition flap has become widely utilized in dermatologic surgery, due to its simplicity and versatility. Herein, we report a case of SCC on the superior helical rim (of which the cartilage was spared) successfully managed with a rhombic transposition flap. The surgical procedure had been relatively simple and the resultant ear helix was free from deformity. In future, we recommend that defects of the ear helix, which have an intact cartilage, should be treated with a rhombic transposition flap to give a successful cosmetic and functional outcome.

Recurrent Basal Cell Carcinomas Treated by Rhombic Transposition Flap / 대한피부과학회지

We report two cases of recurrent BCC in a 51- year-old woman and a 39-year-old woman which had been misdiagnosed aind treated as pigrnented nevi. Complete surgical resections were done followed by reconstruction using local rhombic transposition flaps. Final cosmetic results were excellent and no local recurrence was noticed during one year follow-up.